HomeMy Public PortalAboutButler Av_1516U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 -9.
OMB No. 1660 -0008
Expiration Date: July 31, 2015
SECTION A - PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name Niki Beach, LLC
A2. Building Street Address (including Apt., Unit, Suite, and /or Bklg. No.) or P.O. Route and Box No.
1516 Butler Avenue
Policy Number.
Company NAIC Number.
City Tybee Island
State GA
ZIP Code 31328
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
lots 39, 40 & 41, ward 4 PIN 4 -0008 - 03-014
A4. Budding Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) non- residentiall
A5. Latitude/Longitude: Lat. 31 deq 59.556 min Long. W 80 den 50.945 min Horizontal Datum: ❑ NAD 1927 ® NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1_A
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) rife sq ft
b) Number of permanent flood openings in the crawlspace
or enclosure(s) within 1.0 foot above adjacent grade na
c) Total net area of flood openings in A8.b nla sq in
d) Engineered flood openings? ❑ Yes No
A9. For a building with an attached garage:
a) Square footage of attached garage na sq ft
b) Number of permanent flood openings in the attached garage
within 1.0 foot above adjacent grade n/a
c) Total net area of flood openings in A9.b n/a sq in
d) Engineered flood openings? ❑ Yes ® No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bt. NFIP Community Name & Community Number
Tybee Island 135164
B2. County Name
Chatham
B3. State
GA
B4. Map /Panel Number
1305160326
B5. Suffix
F
B6. FIRM Index Date
9/26108
87. FIRM Panel
Effective /Revised Date
9/26/08
B8. Flood
Zone(s)
AE
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
13
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other /Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929
NAVD 1988 ❑ Other /Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date: ❑ CBRS ❑ OPA
❑ Yes ❑ No
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR/AO. Complete Items C2.a -h
below according to the building diagram specified in Item A7. in Puerto Rico only, enter meters.
Benchmark Utilized: local Vertical Datum: NAVD1988
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 El NAVD 1988 ❑ Other /Source: NAVD 1988
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 15.2 ® feet
b) Top of the next higher floor n /a. ® feet
c) Bottom of the lowest horizontal structural member (V Zones only) n /a. ® feet
d) Attached garage (top of slab) n /a. ® feet
e) Lowest elevation of machinery or equipment servicing the building 15.2 ® feet
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 13.9 ® feet
g) Highest adjacent (finished) grade next to building (HAG) 15.0 ® feet
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support n /a. ® feet
❑ meters
❑ meters
❑ meters
❑ meters
❑ meters
❑ meters
❑ meters
❑ meters
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. I certify that the information on this Certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
❑ Check here if attachments. licensed land surveyor? ❑ Yes ❑ No
Certifier's Name J. Whitley Reynolds License Number 2249
Title Land Sury
Address 6. • Steph
Company Name
nson Avenue
City Savannah State GA ZIP Code 31405
Signat e
FEMA
Date 3/6/14 Telephone 912 - 352 -0464
08633 (7/12) See reverse side for continuation.
Replaces all previous editions.
ELEVATION CERTIFICATE, page 2
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and /or Bldg_ No) or P.O. Route and Box No.
1516 Butler Avenue
FOR INSURANCE COMPANY USE
Policy Number.
City Tybee Island State GA ZIP Code 31328
Company NAIC Number.
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments
Signatu
Date 3/6/14
SECTIO L BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B,
and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and /or equipment servicing the building is . ❑ feet ❑ meters ❑ above or ❑ below the HAG_
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA - issued or community- issued BFE)
or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address
City
State ZIP Code
Signature
Date Telephone
Comments
❑ Check here if attachments.
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G
of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters.
GI . ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA - issued or community- issued BFE) or Zone AO.
G3. ❑ The following information (Items G4 -G10) is provided for community floodplain management purposes.
G4. Permit Number
G5. Date Permit Issued
G6. Date Certificate Of Compliance /Occupancy Issued
G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum
G10. Community's design flood elevation: ❑ feet ❑ meters Datum
Local Official's Name
Title
Community Name
Telephone
Signature
Date
Comments
f1 Check here if attachments.
FEMA Form 086 -0-33 (7/12)
Replaces all previous editions.
ELEVATION CERTIFICATE, page 3
Building Photographs
See Instructions for Item A6.
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
1516 Butler Avenue
Policy Number.
City Tybee Island
State GA ZIP Code 31328
Company NAIC Number.
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions
for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side
View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as
indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
Front View March 6, 2014
FEMA Form 086 -0 -33 (7/12)
Replaces all previous editions.
ELEVATION CERTIFICATE, page 4
Building Photographs
Continuation Page
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
1516 Butler Avenue
Policy Number:
City Tybee Island
State GA ZIP Code 31328
Company NAIC Number:
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
FEMA Form 086 -0-33 (7/12)
Replaces all previous editions.